Hormonal contraception and risk of cervical infections among HIV-1-seropositive Kenyan women
Lavreys, L.; Chohan, V.; Overbaugh, J.; Hassan, W.; McClelland, R.Scott.; Kreiss, J.; Mandaliya, K.; Ndinya-Achola, J.; Baeten, J.M.
Aids 18(16): 2179-2184
2004
ISSN/ISBN: 0269-9370 PMID: 15577651 DOI: 10.1097/00002030-200411050-00010Document Number: 237084
Objective: To evaluate the relationship between hormonal contraceptive use and the acquisition of cervical sexually transmitted infections (STI) among HIV-1-infected women. Design: A prospective cohort study of 242 commercial sex workers in Mombasa, Kenya, followed from the time of HIV-1 infection. Methods: At monthly follow-up visits, sexual behavior and contraceptive use were recorded, and laboratory screening for STI was performed. Multivariate Andersen-Gill proportional hazards models were constructed to examine the association between the use of hormonal contraception and the occurrence of cervical STI. Results: The median duration of follow-up after HIV-1 acquisition was 35 months, and 799 person-years of follow-up were accrued. After adjustment for demographic factors and sexual behavior, women using the injectable contraceptive depot medroxy-progesterone acetate were at increased risk of Chlamydia trachomatis infection [hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.0-9.4, P=0.05] and cervicitis (HR 1.6, 95% CI 1.0-2.3, P=0.03) compared with women using no contraception. The use of oral contraceptive pills was associated with an increased risk of cervicitis (HR 2.3, 95% CI 1.4-3.8, P=0.001). Hormonal contraception was not associated with an increased risk of infection with Neisseria gonorrhoeae. Conclusion: The use of hormonal contraception by HIV-1-infected women was associated with an increased risk of cervicitis and cervical chlamydia infection. HIV-1-seropositive women using hormonal contraception should be counseled about the importance of consistent condom use to prevent both STI and HIV-1 transmission.